The effects of the hospitalization experience on children vary from one child to another. The reasons for this discrepancy can be attributed to differences in the child's cognitive development, age, duration of illness, perception of the concept of illness, level of physical restrictions, presence of pain, type of illness, anxiety levels in parents, readiness for hospitalization, and varying levels of anxiety experienced during hospitalization. Hospitalization leads to anxiety in all children. The reasons why children of all ages show high levels of anxiety symptoms during hospitalization are inadequate preparation for hospitalization, parents' anxiety level, children's lack of knowledge about clinical procedures (lack of child-centered information), and fear of medical procedures (Delvecchio et al., 2019; Johnson et al., 2021; Salmi & Hanson, 2021).

The parents who have to stay with the child throughout the hospitalization process are involved in the process from the first day. This situation paves the way for the development of anxiety in parents (Kaynak & Özçelik, 2020). As invasive nursing procedures are initiated on children, the anxiety levels in parents begin to rise (Pragholapati et al., 2020). Anxiety is a learned and contagious emotion. Therefore, the anxiety experienced by parents begins to affect the child. It has been shown that as parental anxiety increases in children aged 9–12, so does the anxiety in children (Kaynak & Özçelik, 2020).

An additional factor contributing to heightened anxiety levels in hospitalized children is the inaccuracy or insufficiency of health information. It is well-established that providing accurate information about medical procedures results in more favorable emotional and physical outcomes for children (Bray et al., 2019). As children's knowledge about upcoming procedures increases, their anxiety levels decrease. Children typically acquire health information from their parents or individuals in their immediate environment. When the information provider fails to convey information in a manner suitable for the child's age or if their own knowledge is inaccurate or incomplete, it can lead to increased anxiety levels in children. Expectations among children in the 8–12 age group for receiving procedure-related information directly from healthcare professionals are often unmet (Bray et al., 2019; Bray et al., 2022). Therefore, it is essential that health information sessions for children be child-centered and delivered directly by healthcare professionals (Bray et al., 2019).

When the hospitalization experience is not effectively managed in children, it can lead to the development of negative emotions and behaviors such as mistrust of healthcare personnel, refusal to collaborate with healthcare staff, regression, lack of collaboration, withdrawal, aggression, crying, and anxious behaviors (Delvecchio et al., 2019; Li et al., 2016). Health professionals have emphasized the importance of preparing children for clinical procedures through various interventions to reduce their anxiety while highlighting the significance of informing them through a child-centered approach (Bray et al., 2020). When examining interventions aimed at reducing children's fears and anxieties during hospitalization, commonly utilized methods include visual-auditory or solely auditory presentations, videos, development of books-brochures, and drawing pictures (Agüero-Millán et al., 2023; Suleiman-Martos et al., 2022; Tomaszek et al., 2019; Tsao et al., 2017). Although these methods have demonstrated various benefits, it has been noted that computer and web-based interventions are the most effective way to prepare hospitalized children for the hospital environment, with their usage in the healthcare field increasing in recent years (Bray et al., 2020).

Recent studies have incorporated the latest version of web-based interventions, known as serious gaming initiatives. With the increasing interest of children in games and the internet, serious games are recognized as an opportunity to be utilized in anxiety management, which is a nursing intervention (Buffel et al., 2019; Matthyssens et al., 2020). Serious game interventions in child health are observed to focus on children undergoing surgery and those with chronic illnesses (Buffel et al., 2019; Eijlers et al., 2019). Despite the recommendation for the use of serious gaming interventions by healthcare professionals to help hospitalized children adapt to their environment (Jin & Kim, 2019), literature review revealed no serious game specifically designed for this purpose. The aim of the study is to examine the effects of the developed serious game on the anxiety, fear and knowledge of children aged 8–12 who were hospitalized for the first time and the anxiety levels of their parents.

The hypotheses of the study are; H1: The anxiety levels of the children in the study group are lower than the control group, H2: The clinical knowledge level of the children in the study group is higher than the control group, H3: The medical procedure fear level of the children in the study group is lower than the control group, H4: The anxiety level of the parents of children in the study group is lower than the control group.